Search
Knowledgebase

Breast Cancer: Should I Have Breast-Conserving Surgery or a Mastectomy for Early-Stage Cancer?

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

In a lumpectomy,
the doctor cuts out the tumor and some of the breast tissue around it. You may
also hear this called an "excisional biopsy" or "wide excision."

In a partial or segmental mastectomy, the doctor cuts
out the tumor and a larger section of breast tissue around it. He or she also
cuts out the lining over the chest muscles below the tumor. But most of your
breast remains.

The removal of the entire breast is
called a total or simple mastectomy.

The
removal of the breast, the lymph nodes under the arm (axillary lymph nodes),
the lining over the chest muscles, and sometimes part of the chest wall muscles
is called a modified radical mastectomy.

How far the cancer has spread within your breast and
whether it has spread to nearby tissues or other organs is called the
stage. Your doctor will find out the stage of your
breast cancer by gathering information from other tests such as lymph node
biopsies, blood tests, bone scans, and X-rays.

The stage of your cancer is one
of the most important things to think about when you choose the treatment
option that is right for you. You'll also want to think about your feelings about losing your entire breast or just part of it. The surgery for mastectomy will be more involved, and recovery will take longer.

If you prefer breast-conserving surgery but are worried about radiation treatments, check with your doctor. Some women, such as those who are age 70 or older, may not need radiation.

For many years, experts thought that having a mastectomy would help you
live longer and reduce the chance that your breast cancer would come back
(recur). Breast-conserving surgery does have a slightly higher chance of the
cancer returning. But studies now show that women who have breast-conserving
surgery followed by radiation treatments have the same survival rates as women
who have mastectomy.1

You have two or more areas of breast cancer
in the same breast that are too far apart to be removed with a single cut
(incision).

You have precancerous changes in more than one-quarter
of your breast (one breast quadrant) or throughout one or both breasts.

Your breast cancer is large or is large relative to the size of
your breast, and removing it will require removing a lot of breast tissue. You
may not be satisfied with the way your breast looks after surgery.

You tested positive for the BRCA gene change. This means that you have a high risk for a second breast cancer. You may also want to consider having your other breast removed to reduce your risk.

You are pregnant or you have another health reason that keeps you from being able to have radiation. Those reasons may include a serious lung disease, a connective tissue disease, or a problem that was already treated with radiation to the breast or chest.

Compare your options

Compare

What is usually involved?

What are the benefits?

What are the risks and side effects?

Have a mastectomy
Have a mastectomy

You will stay overnight in
the hospital.

Breast reconstruction is possible. It may involve
one or more surgeries.

You may or may not need radiation treatment
afterward.

Like breast-conserving
surgery, mastectomy can help you live longer.

You may not need to
have daily radiation treatment after surgery.

Removing a
breast without doing reconstructive surgery can cause a weight shift, leading
to neck and back pain. This is more common if you have large
breasts.

Some women are disappointed with the way they look after
mastectomy, even with reconstruction.

A reconstructed breast does not have the
sensitivity of your natural breast.

With breast
reconstruction, there are risks from additional surgeries.

Have breast-conserving
surgery Have breast-conserving
surgery

There's no need
to stay in the hospital overnight.

You will probably have daily
radiation treatments for 3 to 6 weeks.

Like mastectomy,
breast-conserving surgery can help you live longer.

You will keep more of your natural breast, which will have more sensitivity than a reconstructed breast.

Surgery usually leaves only a small scar, so you
won't need breast reconstruction or an artificial breast.

Because more breast tissue remains, there is a slightly higher chance of the
cancer coming back in that breast. If this happens, the chances of survival are
not affected, but you will then need to have a mastectomy.

Radiation often has side effects, including fatigue and a slight change in the
color of your skin.

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

I don't want
to lose my breast. It is a part of me, and I don't believe that I would feel
the same way about myself if it were gone. Wearing a prosthesis seems like a
hassle, and I don't want to have more surgery to reconstruct my breast, so the
lumpectomy feels like the right choice for me. I don't mind going for the
radiation treatments.

Maggie, age 61

I live about 60 miles from the nearest
cancer center. Traveling to and from there each day will just be too much for
me. I would rather have a mastectomy and not have to go through 6 more weeks of
treatment. At some point, I may decide to have reconstructive surgery to
restore my breast, but I can't take that much time off from my job right now.

Ellen, age
49

I don't want to have a daily reminder, a
flat spot on my chest wall, about this cancer. I want the doctor to take out
only what is necessary. I think if I had a mastectomy, my scar would be a
constant reminder of my cancer, even if I chose to have reconstruction. Also, I
work really close to the cancer center, so it will be easy for me to have my
treatments.

Joan, age
52

I don't want to have radiation treatments.
I know that it is not the same today as it was years ago, but I still am
concerned about the side effects and the weeks and weeks of treatments. I'm
glad that I have the choice. I am certain that I do not want to have radiation,
so mastectomy seems like the right choice for me. Maybe some day I will have
reconstructive surgery, but right now I just want to get on with my life.

Beth, age
65

What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to choose mastectomy

Reasons to choose breast-conserving surgery

I am worried that breast-conserving surgery will not remove all of the cancer.

I don't mind trying breast-conserving surgery first and having a mastectomy if it's needed to remove all of the cancer.

More important

Equally important

More important

Keeping my breast is not as important as getting rid of all the cancer.

I really want to keep most of my breast.

More important

Equally important

More important

I am worried about having radiation treatment or side effects such as fatigue and skin changes.

I am worried about problems after mastectomy, such as neck and back pain.

More important

Equally important

More important

I'm worried about the inconvenience of radiation treatment, such as extra time and daily travel.

Time and travel for radiation treatment isn't a concern.

More important

Equally important

More important

My other important reasons:

My other important reasons:

More important

Equally important

More important

Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Mastectomy

Breast-conserving surgery

Leaning toward

Undecided

Leaning toward

What else do you need to make your decision?

Check the facts

1.

Which option has a slightly higher chance that the cancer will return in the same breast?

MastectomyNo, that's wrong. The right answer is breast-conserving surgery. It leaves behind more breast tissue, so there is a slightly higher chance of the cancer coming back in that breast.

Breast-conserving surgeryYou are right. Breast-conserving surgery leaves behind more breast tissue, so there is a slightly higher chance of the cancer coming back in that breast.

Both are equalNo, that's wrong. The right answer is breast-conserving surgery. It leaves behind more breast tissue, so there is a slightly higher chance of the cancer coming back in that breast.

I'm not sureIt may help to go back and read "Compare Your Options." Breast-conserving surgery leaves behind more breast tissue, so there is a slightly higher chance of the cancer coming back in that breast.

2.

Which option has the higher chance of survival?

MastectomyNo, that's not right. Experts used to think that mastectomy was better. But studies now show that breast-conserving surgery followed by radiation treatments is as good as mastectomy in treating early-stage breast cancer.

Breast-conserving surgeryNo, that's not right. Actually, mastectomy and breast-conserving surgery followed by radiation treatments are equally good at treating early-stage breast cancer.

Both are equalYou are right. Studies show that breast-conserving surgery followed by radiation treatments is as good as mastectomy in treating early-stage breast cancer.

I'm not sureIt may help to go back and read "Get the Facts." Breast-conserving surgery followed by radiation treatments is as good as mastectomy in treating early-stage breast cancer.

3.

Which option has the higher chance of side effects from radiation, such as fatigue?

MastectomyNo, that's wrong. The right answer is breast-conserving surgery. Radiation isn't usually used after a mastectomy for early-stage breast cancer. It is normally used after breast-conserving surgery.

Breast-conserving surgeryYou are right. After you have this surgery, you will need radiation treatments. Radiation often has side effects, including fatigue and a slight change in the color of your skin.

Both are equalNo, that's wrong. The right answer is breast-conserving surgery. Radiation isn't usually used after a mastectomy for early-stage breast cancer. It is normally used after breast-conserving surgery.

I'm not sureIt may help to go back and read "Compare Your Options." Radiation isn't usually used after a mastectomy for early-stage breast cancer. It is normally used after breast-conserving surgery.

You may want to have a say in this decision, or you may simply want to follow your doctor's recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.

Breast Cancer: Should I Have Breast-Conserving Surgery or a Mastectomy for Early-Stage Cancer?

Here's a record of your answers. You can use it to talk with your doctor or loved ones about your decision.

Get the facts

Compare your options

What matters most to you?

Where are you leaning now?

What else do you need to make your decision?

1. Get the Facts

Your options

Have surgery to remove the breast (mastectomy).

Have surgery to remove just
the cancer from the breast (breast-conserving surgery) followed by radiation
treatments.

Key points to remember

For early-stage breast cancer, studies show
that women who have breast-conserving surgery followed by radiation treatments
have the same survival rates as women who have mastectomy.

Breast-conserving surgery has a slightly higher chance of the
cancer returning.

The
stage of your cancer—how far it has spread—is very important in deciding which
treatment is best.

Breast-conserving surgery may be a better
choice if the tumor is small or if it is at the edge of the
breast.

Mastectomy may be a better choice if you have two or more
areas of cancer in the same breast that would need more than one cut, or
incision.

If you choose mastectomy, you may choose to have surgery to
rebuild your breast. This is called reconstructive surgery.

Mastectomy is major surgery. Your recovery will take longer than if you had breast-conserving surgery. And if you have reconstruction, you will likely need more surgery and recovery time.

This is a very personal decision. Your feelings about keeping
your breast are just as important as anything else in choosing what feels right
for you.

FAQs

What is breast cancer?

Breast cancer
occurs when abnormal cells grow out of control in the breast. Early-stage breast cancer is when the cancer cells haven't spread beyond the breast or the lymph nodes in the armpit.

What types of surgery are used to treat breast cancer?

The two different types of surgery used to treat early-stage breast
cancer are:

In a lumpectomy,
the doctor cuts out the tumor and some of the breast tissue around it. You may
also hear this called an "excisional biopsy" or "wide excision."

In a partial or segmental mastectomy, the doctor cuts
out the tumor and a larger section of breast tissue around it. He or she also
cuts out the lining over the chest muscles below the tumor. But most of your
breast remains.

The removal of the entire breast is
called a total or simple mastectomy.

The
removal of the breast, the lymph nodes under the arm (axillary lymph nodes),
the lining over the chest muscles, and sometimes part of the chest wall muscles
is called a modified radical mastectomy.

What will help you decide which type of surgery to choose?

How far the cancer has spread within your breast and
whether it has spread to nearby tissues or other organs is called the
stage. Your doctor will find out the stage of your
breast cancer by gathering information from other tests such as lymph node
biopsies, blood tests, bone scans, and X-rays.

The stage of your cancer is one
of the most important things to think about when you choose the treatment
option that is right for you. You'll also want to think about your feelings about losing your entire breast or just part of it. The surgery for mastectomy will be more involved, and recovery will take longer.

If you prefer breast-conserving surgery but are worried about radiation treatments, check with your doctor. Some women, such as those who are age 70 or older, may not need radiation.

Does one type of surgery work better than the other?

For many years, experts thought that having a mastectomy would help you
live longer and reduce the chance that your breast cancer would come back
(recur). Breast-conserving surgery does have a slightly higher chance of the
cancer returning. But studies now show that women who have breast-conserving
surgery followed by radiation treatments have the same survival rates as women
who have mastectomy.1

You have two or more areas of breast cancer
in the same breast that are too far apart to be removed with a single cut
(incision).

You have precancerous changes in more than one-quarter
of your breast (one breast quadrant) or throughout one or both breasts.

Your breast cancer is large or is large relative to the size of
your breast, and removing it will require removing a lot of breast tissue. You
may not be satisfied with the way your breast looks after surgery.

You tested positive for the BRCA gene change. This means that you have a high risk for a second breast cancer. You may also want to consider having your other breast removed to reduce your risk.

You are pregnant or you have another health reason that keeps you from being able to have radiation. Those reasons may include a serious lung disease, a connective tissue disease, or a problem that was already treated with radiation to the breast or chest.

2. Compare your options

Have a mastectomy

Have breast-conserving
surgery

What is usually involved?

You will stay overnight in
the hospital.

Breast reconstruction is possible. It may involve
one or more surgeries.

You may or may not need radiation treatment
afterward.

There's no need
to stay in the hospital overnight.

You will probably have daily
radiation treatments for 3 to 6 weeks.

What are the benefits?

Like breast-conserving
surgery, mastectomy can help you live longer.

You may not need to
have daily radiation treatment after surgery.

Like mastectomy,
breast-conserving surgery can help you live longer.

You will keep more of your natural breast, which will have more sensitivity than a reconstructed breast.

Surgery usually leaves only a small scar, so you
won't need breast reconstruction or an artificial breast.

What are the risks and side effects?

Removing a
breast without doing reconstructive surgery can cause a weight shift, leading
to neck and back pain. This is more common if you have large
breasts.

Some women are disappointed with the way they look after
mastectomy, even with reconstruction.

A reconstructed breast does not have the
sensitivity of your natural breast.

With breast
reconstruction, there are risks from additional surgeries.

Because more breast tissue remains, there is a slightly higher chance of the
cancer coming back in that breast. If this happens, the chances of survival are
not affected, but you will then need to have a mastectomy.

Radiation often has side effects, including fatigue and a slight change in the
color of your skin.

Personal stories

Are you interested in what others decided to do? Many people have faced this decision. These
personal stories
may help you decide.

These stories are based on information gathered from health professionals and consumers. They may be helpful as you make important health decisions.

"I don't want to lose my breast. It is a part of me, and I don't believe that I would feel the same way about myself if it were gone. Wearing a prosthesis seems like a hassle, and I don't want to have more surgery to reconstruct my breast, so the lumpectomy feels like the right choice for me. I don't mind going for the radiation treatments."

— Maggie, age 61

"I live about 60 miles from the nearest cancer center. Traveling to and from there each day will just be too much for me. I would rather have a mastectomy and not have to go through 6 more weeks of treatment. At some point, I may decide to have reconstructive surgery to restore my breast, but I can't take that much time off from my job right now."

— Ellen, age
49

"I don't want to have a daily reminder, a flat spot on my chest wall, about this cancer. I want the doctor to take out only what is necessary. I think if I had a mastectomy, my scar would be a constant reminder of my cancer, even if I chose to have reconstruction. Also, I work really close to the cancer center, so it will be easy for me to have my treatments."

— Joan, age
52

"I don't want to have radiation treatments. I know that it is not the same today as it was years ago, but I still am concerned about the side effects and the weeks and weeks of treatments. I'm glad that I have the choice. I am certain that I do not want to have radiation, so mastectomy seems like the right choice for me. Maybe some day I will have reconstructive surgery, but right now I just want to get on with my life."

— Beth, age
65

3. What matters most to you?

Your personal feelings are just as important as the medical facts. Think about what matters most to you in this decision, and show how you feel about the following statements.

Reasons to choose mastectomy

Reasons to choose breast-conserving surgery

I am worried that breast-conserving surgery will not remove all of the cancer.

I don't mind trying breast-conserving surgery first and having a mastectomy if it's needed to remove all of the cancer.

More important

Equally important

More important

Keeping my breast is not as important as getting rid of all the cancer.

I really want to keep most of my breast.

More important

Equally important

More important

I am worried about having radiation treatment or side effects such as fatigue and skin changes.

I am worried about problems after mastectomy, such as neck and back pain.

More important

Equally important

More important

I'm worried about the inconvenience of radiation treatment, such as extra time and daily travel.

Time and travel for radiation treatment isn't a concern.

More important

Equally important

More important

My other important reasons:

My other important reasons:

More important

Equally important

More important

4. Where are you leaning now?

Now that you've thought about the facts and your feelings, you may have a general idea of where you stand on this decision. Show which way you are leaning right now.

Mastectomy

Breast-conserving surgery

Leaning toward

Undecided

Leaning toward

5. What else do you need to make your decision?

Check the facts

1.
Which option has a slightly higher chance that the cancer will return in the same breast?

Mastectomy

Breast-conserving surgery

Both are equal

I'm not sure

You are right. Breast-conserving surgery leaves behind more breast tissue, so there is a slightly higher chance of the cancer coming back in that breast.

2.
Which option has the higher chance of survival?

Mastectomy

Breast-conserving surgery

Both are equal

I'm not sure

You are right. Studies show that breast-conserving surgery followed by radiation treatments is as good as mastectomy in treating early-stage breast cancer.

3.
Which option has the higher chance of side effects from radiation, such as fatigue?

Mastectomy

Breast-conserving surgery

Both are equal

I'm not sure

You are right. After you have this surgery, you will need radiation treatments. Radiation often has side effects, including fatigue and a slight change in the color of your skin.

Decide what's next

1.
Do you understand the options available to you?

Yes

No

2.
Are you clear about which benefits and side effects matter most to you?

Yes

No

3.
Do you have enough support and advice from others to make a choice?

Note: The "printer friendly" document will not contain all the information available in the online document some Information (e.g. cross-references to other topics, definitions or medical illustrations) is only available in the online version.

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use.
How this information was developed to help you make better health decisions.